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The Executive Yuan in Taiwan plans to install air-conditioning (A/C) in all elementary schools within two years. However, besides the associated energy consumption and environmental issues, the use of A/C will inevitably result in the doors and windows of the classroom being closed, which will increase the accumulation of carbon dioxide (CO2) within the classroom. An excessive indoor CO2 concentration can result in reduced cognitive performance and an impaired learning efficiency. Therefore, the moderate introduction of external air into the classroom is essential to increase the air exchange rate (AER) and reduce the CO2 concentration level. Accordingly, the present study conducts a numerical investigation into the effects of various A/C operation strategies on the CO2 concentration within the classroom given different proportions of students remaining in the classroom during the recess. Overall, the results indicate that the optimal usage strategy is to operate the A/C over the full school day (08:00~15:50 p.m.) in conjunction with a mechanical ventilation system providing a fresh air exchange rate of 5 l/s for every person in the room. However, the use of a mechanical ventilation system inevitably incurs an additional hardware and energy consumption. Thus, an alternative recommendation is also proposed, in which the windows are opened and the air conditioner is turned off at every recess and during the lunchtime period. It is shown that the resulting CO2 concentration in the classroom is still consistent with the Taiwan Environmental Protection Administration (EPA) regulations and the thermal comfort of the students is achieved for more than three-quarters of the school day.

The relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p  < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p  < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p  = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.

Agriculture accounts for 29% of the Gross Domestic Product of the Nusa Tenggara Islands (NTIs). However, recurring agricultural droughts pose a major threat to the sustainability of agriculture in this region. The interplay between precipitation, solar radiation, and surface temperature as meteorological factors plays a key role in affecting vegetation (Soil-Adjusted Vegetation Index) and agricultural drought (Temperature Vegetation Dryness Index) in the NTIs. Based on the analyses of interplay with temporal lag, this study investigates the effect of each factor on agricultural drought and attempts to provide early warnings regarding drought in the NTIs. We collected surface information data from Moderate-Resolution Imaging Spectroradiometer (MODIS). Meanwhile, rainfall was estimated from Himawari-8 based on the INSAT Multi-Spectral Rainfall Algorithm (IMSRA). The results showed reliable performance for 8-day and monthly scales against gauges. The drought analysis results reveal that the NTIs suffer from mild-to-moderate droughts, where cropland is the most vulnerable, causing shifts in the rice cropping season. The driving factors could also explain >60% of the vegetation and surface-dryness conditions. Furthermore, our monthly and 8-day TVDI estimation models could capture spatial drought patterns consistent with MODIS, with coefficient of determination (R2) values of more than 0.64. The low error rates and the ability to capture the spatial distribution of droughts, especially in open-land vegetation, highlight the potential of these models to provide an estimation of agricultural drought.

When hot forging 7075 aluminum alloy, as a military material durable enough for most of its applications, it needs to be heat-treated to ensure the target material property achieves the application requirements. However, the material properties change because of heat throughout usage. In this study, a new approach was devised to heat treat the alloy to prevent material property changes. The study further clarified the effect of rapid heat treatment on the high-temperature resistance of a hot forging 7075 aluminum alloy. Infrared (IR) heat treatment was used as a rapid heating technique to effectively replace the conventional resistance heat (RH) treatment method. Our experimental result showed that IR heat treatment resulted in better age hardening at the initial aging stage, where its tensile strength and elongation appeared like that of a resistance heat treatment. More so, based on hardness and tensile test results, the IR-heated treatment process inhibited the phase transformation of precipitations at a higher temperature, improving high-temperature softening resistance and enhancing the thermal stability of the hot forging 7075 aluminum alloy.

Among various natural hazards, floods stand out due to their frequency and severe impact on society and the environment. This study aimed to develop a flood susceptibility model for Demak District, Indonesia, by integrating remote sensing data, machine learning techniques, and CMIP6 Global Climate Model (GCM) data. The approach involved mapping current flood susceptibility using Sentinel-1 SAR data as the flood inventory and applying machine learning algorithms such as MLP-NN, Random Forest, Support Vector Machine (SVM), and XGBoost to predict flood-prone areas. Additionally, future flood susceptibility was projected using CMIP6 GCM precipitation data under three Shared Socioeconomic Pathway (SSP) scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5) covering the 2021–2100 period. To enhance the reliability of future projections, a multi-model ensemble approach was employed by combining the outputs of multiple GCMs to reduce model uncertainties. The results showed a significant increase in flood susceptibility, especially under higher emission scenarios (SSP5-8.5), with very high susceptibility areas growing from 16.67% in the current period to 27.43% by 2081–2100. The XGBoost model demonstrated the best performance in both current and future projections, providing valuable sustainable planning insights for flood risk management and adaptation to climate change.

To establish a Global Trigger Tool (GTT) method suitable for monitoring adverse drug events (ADEs) in the high-risk elderly inpatients with multiple chronic diseases, and to evaluate its sensitivity, specificity and feasibility. A total of 38 triggers were established by searching the literature and combining the characteristics of elderly hospitalized patients with multiple chronic diseases in Taizhou People's Hospital. A total of 480 elderly patients with multiple chronic diseases were sampled from January to December 2023, and the cases were reviewed. Adverse event grades were determined, and drug classes and organ-systems involved were analyzed; binary logistic regression and Receiver Operating Characteristic curves were adopted for analysis. Among the 480 cases, 123 cases were detected as having one or more positive triggers. ADEs occurred in 65 patients, with a total of 93 occurrences of ADEs; the highest number of ADE cases was observed in the administration of cardiovascular drugs, with 36 cases (38.71%). The highest organ-system involved in ADE was metabolic and nutritional disorders, with 47 cases (50.54%). The number of ADEs occurring in 1,000 patient-days was 22.90. The number of ADEs occurring in 100 patients was 19.38. Using binary logistic regression analysis, the risk factors were age and number of positive trigger detections for predicting the occurrence of ADEs. The GTT method had a sensitivity of 78.46%; specificity of 82.65%; compliance rate of 82.00%; Kappa value of 44.40%; and the Positive Predictive Value (PPV) was 41.46%. The GTT method has high sensitivity and specificity and is feasible; it has a relatively high PPV and is suitable for detecting ADEs in the high-risk elderly inpatients with multiple chronic diseases.

Antibiotic-driven dysbiosis may impair immune function and reduce vaccine-induced antibody titers. This study aims to investigate the impacts of early-life antibiotic exposure on subsequent varicella and breakthrough infections. This is a nationwide matched cohort study. From Taiwan's National Health Insurance Research Database, we initially enrolled 187,921 children born from 1997 to 2010. Since 2003, the Taiwan government has implemented a one-dose universal varicella vaccination program for children aged 1 year. We identified 82,716 children born during the period 1997 to 2003 (pre-vaccination era) and 48,254 children born from July 1, 2004, to 2009 (vaccination era). In the pre-vaccination era, 4,246 children exposed to antibiotics for at least 7 days within the first 2 years of life (Unvaccinated A-cohort) were compared with reference children not exposed to antibiotics (Unvaccinated R-cohort), with 1:1 matching for gender, propensity score, and non-antibiotic microbiota-altering medications. Using the same process, 9,531 children in the Vaccinated A-cohort and Vaccinated R-cohort were enrolled from the vaccination era and compared. The primary outcome was varicella. In each era, demographic characteristics were compared, and cumulative incidences of varicella were calculated. Cox proportional hazards model was used to examine associations. In the pre-vaccination era, the 5-year cumulative incidence of varicella in the Unvaccinated A-cohort (23.45%, 95% CI 22.20% to 24.70%) was significantly higher than in the Unvaccinated R-cohort (16.72%, 95% CI 15.62% to 17.82%) (p<.001). In the vaccination era, a significantly higher 5-year cumulative incidence of varicella was observed in the Vaccinated A-cohort (1.63%, 95% 1.32% to 1.93%) than in the Vaccinated R-cohort (1.19%, 95% CI 0.90% to 0.45%) (p=0.006). On multivariate analyses, early-life antibiotic exposure was an independent risk factor for varicella occurrence in the pre-vaccination (adjusted hazard ratio [aHR] 1.92, 95% CI 1.74 to 2.12) and vaccination eras (aHR 1.66, 95% CI 1.24 to 2.23). The use of penicillins, cephalosporins, macrolides, or sulfonamides in infancy was all positively associated with childhood varicella regardless of vaccine administration. Antibiotic exposure in early life is associated with varicella occurrence and breakthrough infections.

Background This study explored the impact of MTM service on MMD patients with hypertension. Methods A total of 120 MMD inpatients from September to November 2019 were received and randomly divided into intervention group and control group. General services for noninfectious chronic diseases were given to the control group, while a standard MTM service was given to the intervention group. Patients’ blood pressure, EQ-5D utility value, readmission rate, drug-related problems, and average daily medication therapy cost were compared between the two groups and within the groups. This was done at the initial admission phase and in the first, third, sixth, and twelfth months after discharge. Results The intervention group had significantly lower blood pressure and average daily medication therapy cost 12 months after discharge compared to the control group (systolic blood pressure: P  = 0.023, diastolic blood pressure: P  < 0.001, average daily medication therapy cost: P  = 0.049); the number of DRPs decreased in both groups 12 months after discharge; the number of DRPs solved in the intervention group in the third, sixth and twelfth months after discharge were statistically higher compared with that in the control group ( P  = 0.013, P  = 0.012, P  = 0.001); there was no significant difference in the EQ-5D utility value and readmission rate between the two groups ( P  > 0.05). Conclusions MTM implementation in MMD patients can improve health outcomes and reduce healthcare-related costs among MMD patients. Trial registration Chinese Clinical Trial Register ChiCTR2200065111, date of registration: October 28, 2022.

DDX6 is a conserved DEAD-box protein (DBP) that plays central roles in cytoplasmic RNA regulation, including processing body (P-body) assembly, mRNA decapping, and translational repression. Beyond its cytoplasmic functions, DDX6 may also have nuclear functions because its orthologues are known to localize to nuclei in several biological contexts. However, it is unclear whether DDX6 is generally present in human cell nuclei, and the molecular mechanism underlying DDX6 subcellular distribution remains elusive. In this study, we showed that DDX6 is commonly present in the nuclei of human-derived cells. Our structural and molecular analyses deviate from the current model that the shuttling of DDX6 is directly mediated by the canonical nuclear localization signal (NLS) and nuclear export signal (NES), which are recognized and transported by Importin-α/β and CRM1, respectively. Instead, we show that DDX6 can be transported by 4E-T in a piggyback manner. Furthermore, we provide evidence for a novel nuclear targeting mechanism in which DDX6 enters the newly formed nuclei by “hitch-hiking” on mitotic chromosomes with its C-terminal domain during M phase progression. Together, our results indicate that the nucleocytoplasmic localization of DDX6 is regulated by these dual mechanisms.

Post-forging heat treatment is often necessary to achieve the mechanical properties required for aluminum alloy forged parts. In this study, hot-forged 6082 suspension parts are used to study the effect of rapid infrared (IR) heat treatment. The insoluble particles present in the matrix after the solutionizing process are observed. Experimental results show that using rapid IR heat treatment leads to superior solutionizing, and thus a larger critical onset strain in serrated tensile flow. The rapid IR heat treatment also had a more significant precipitation effect, which enhanced the mechanical properties of the material.